Nephron-sparing Surgery In The Treatment Of Renal Cell Carcinoma(Report Of112Cases)

Objective To evaluate the safety and efficacy of nephron sparing surgery for renalcell carcinoma． Methods A total of112patients,69were male and43female, with an averageage50.04(19-80) years. The mean diameter of the tumors was3.45(1.1-7.7)cm. Eighty-ninecases received open NSS,17cases received retroperitoneal laparoscopic NSS, other6casesreceived Transperitoneal NSS. The perioperative data and renal function， operative andpostoperative complications were evaluated. Results The mean operating time was169(60-340) min in all112patients. Artery and vein (AV) were clamped in two (1.79%) patients,are all via retroperitoneal open partial nephrectomy.Sixty-six(58.93%) patients, consist of50cases received open NSS,13cases received retroperitoneal laparoscopic NSS and6casesreceived laparoscopic NSS, artery was clamped alone (AO) in which26patients had a meanischemia time of32(10-80) minutes,. Twenty-six cases had a warm ischemia with a meanischemia time of24.4（10-50）minutes，40patients had a cold ischemia with a meanischemia time of37.4（20-80）minutes, and44(39.29%) patients had unclamped (U) technique.The mean blood loss was273.0(10-3000)ml and7cases required a intraoperative bloodtransfusion，2cases required a postoperative blood transfusion. Thirty patients receivedintraoperative retrograde catheterization of ureter，twenty-eight patients received closure ofthe collecting system. All patients were placed a postoperative drainage tube in theretroperitoneal. The mean retroperitoneal drainage volume in the first three days was259.4(4-1360)ml, the mean draining time was7.2days. The postoperative creatinine compare ofpreoperative creatinine was higher in38.77umol/L, higher than the base value of50.07%. Nopatients suffer acute kidney function failure. One case received open adrenalectomy because ofhomolateral adrenal adenoma diagnosed in the preoperation,1case received openadrenalectomy because of homolateral adrenal invasion by the renal cell carcinoma, Onecase was complicated with urine leakage,1case was complicated with chylous fistula and1case was complicated with renal artery embolization in the OPN group. One case received OPNbecause of intraoperative hemorrhage and1case because of renal cell carcinoma diagnosed byfrozen pathological section during operation in the LPN group. The mean time of thepostoperative fasting was3.1(2-6) days. The mean hospital stays was21.12(11-70) days, thepostoperative hospital stays was11.98(4-47) days. Postoperative pathologic results:80casesof malignant tumor, included57cases clear renal cell carcinoma，13cases papillary renal cellcarcinoma，5cases h chromophobe renal carcinoma，3cases h multilocular cystic renal cell carcinoma，1case the mucinous tubular and spindle cell carcinoma(MTSCC) of kidney and1case mixed cell carcinoma;32cases of benign tumors:5cases renal oncocytoma，27casesrenal angiomyolipoma. The histopathological examination of80cases of malignant tumorshowed that57pT1aN0M0cases,13pT1bN0M0cases,3pT2aN0M0cases, pT3aN0M02examples; Conclusions Both open and laparoscopic nephron sparing surgery has excellentsafety and superior effectiveness in treating small renal tumor and part of≥4cm renal cellcarcinoma. The key of protect kidney function is reduce ischemic time. It may decrease urineleakage and postoperative hemorrhage occurrence by intraoperative retrogradecatheterization of ureter and absorbable styptic gauze stuffing and use of biomedical fibringlue in the renal parenchyma surgical wound.